Contemplative practice treatments for post-traumatic stress


Two weeks ago, U.S. Army veteran Stephen Lee described in a Huffington Post interview how his participation in a meditation study helped him work with the anger and anxiety he was suffering as a result of post-traumatic stress. Lee is featured in Free the Mind, a new documentary about the brain, neuroscience, and meditation.


Recent research suggests that contemplative practices may be helpful in alleviating some of the torment caused by post-traumatic stress, in particular that of combat veterans and civilians in postwar regions.


Last April, a team from the University of Michigan’s Department of Psychiatry published a pilot study in the journal Depression and Anxiety showing that “veterans with PTSD who completed an 8-week mindfulness-based group treatment plan showed a significant reduction in symptoms as compared to patients who underwent treatment as normal.”


The treatment plan included the use of MBCT, or mindfulness-based cognitive therapy, which combines standard forms of cognitive therapy with a more contemplative, meditative, or mindful approach that stresses “an increased awareness of all thoughts and emotions.”


A Science Daily article written about the pilot study says “previous research has shown stress reduction classes that use mindfulness meditation have been beneficial to people with a history of trauma exposure – including veterans, civilians with war-related trauma, and adults with a history of childhood sexual abuse – but the new study is the first to examine the effect of mindfulness-based psychotherapy for PTSD with veterans in a PTSD clinic.”


Other psychotherapy programs that have demonstrated some efficacy in alleviating PTSD symptoms include different variants of exposure therapy, and a type of therapy known as eye movement desensitization and reprocessing (EMDR). Although there is some unresolved controversy surrounding the efficacy of particular forms of PTSD treatment, multiple meta-analyses conclude that trauma-focused psychological treatments — for example, EMDR and trauma-focused cognitive behavior therapy (CBT) – are effective treatments for post-traumatic stress disorder.


The American Psychiatric Association, the U.S. Department of Veterans Affairs, the U.S. Department of Defense, and several international bodies have recommended EMDR and CBT in particular as effective treatment strategies for the alleviation of post-traumatic stress. Such associations and departments may begin recommending treatment plans that incorporate contemplative practices if studies continue to suggest positive effects.


A 2008 study published in the Journal of Clinical Psychiatry, for example, set out to determine whether participation in a mind-body skills program could decrease symptoms of PTSD in a group of postwar Kosovar adolescents. The group program was based on psychological self-care, mind-body techniques such as meditation and breathing techniques, and self-expression exercises, and was administered to 82 adolescents meeting criteria for PTSD according to the Harvard Trauma Questionnaire. Students in the intervention group had significantly lower PTSD symptom scores following intervention than those in the wait-list control group.


Further, a 2013 literature review published in the Journal of Investigative Medicine surveyed a number of academic databases in order to identify the effects of mind-body interventions – such as yoga, tai chi, qigong, mindfulness-based stress reduction, meditation, and deep breathing – as interventions for PTSD. The literature search used the databases PubMed, PsycINFO, and Published International Literature on Traumatic Stress, which resulted in 92 articles, only 16 of which were deemed suitable for inclusion in the review.


Findings from the 16 publications “suggest that mind-body practices are associated with positive impacts on PTSD symptoms. Mind-body practices incorporate numerous therapeutic effects on stress responses, including reduction in anxiety, depression, and anger, and increases in pain tolerance, self-esteem, energy levels, ability to relax, and ability to cope with stressful situations. In general, mind-body practices were found to be a viable intervention to improve the constellation of PTSD symptoms such as intrusive memories, avoidance, and increased emotional arousal.”


Likewise, Dr. Anthony P. King, the lead author of the pilot study from the University of Michigan, says that one of the most noticeable areas of improvement for combat veterans suffering from PTSD was a reduction in “avoidance symptoms.” One of the central objectives of mindfulness meditation and therapy is an attempt to develop sustained focus on thoughts and memories, even ones that may be unpleasant.


King says “part of the psychological process of PTSD often includes avoidance and suppression of painful emotions and memories, which allows symptoms of the disorder to continue… through the mindfulness intervention, however, we found that many of our patients were able to stop this patter of avoidance and see an improvement in their symptoms.” Patients in the mindfulness group also experienced a decrease in feelings of guilt, self-blame, shame, and a trend towards decreased perception of the world as a dangerous place, in part because “mindfulness techniques also emphasize focus and attention to positive experiences and nonjudgmental acceptance to one’s thoughts and emotions.”


Though such studies and literature reviews are encouraging, further studies with larger sample sizes and rigorous designs are needed to fully explore the implications of introduction contemplative practices to the treatment of posttraumatic stress. It remains to be seen whether such practices can function as independent interventions for treating avoidance and other symptoms of anxiety, or whether they should be considered a complement to existing treatments such as cognitive-behavioral therapies and EMDR.



November 21, 2013
Correction: The original version of this article incorrectly referred to a 2010 study by Ehlers, A. et al. as a meta-analysis. The study is more accurately described as a critical response to a previous, 2008 meta-analysis by Benish, SG. et al. The original version of this article also misstated the conclusion of Ehlers, A. et al (2010), which does not question the efficacy of PTSD treatments altogether, but does question certain claims about PTSD treatments found in Benish, SG. et al (2008). Furthermore, Ehlers, A. et al. (2010) cites several meta-analyses that conclude that “trauma-focused psychological treatments, such as individual trauma-focused cognitive behavior therapy (TFCBT) and eye movement desensitization reprocessing (EMDR) are efficacious” treatments for post-traumatic stress disorder.